Effect of Haemodialysis on Upper Gastrointestinal Tract Pathology in Patients With Chronic Renal Failure

Upper gastrointestinal tract pathology observed at autopsy in94 patients with end-stage renal disease (GFR<10 ml/min)was analysed retrospectively. To better evaluate the effectof haemodialysis on this pathology, the chronic renal failurepatients were subdivided into three groups: 19 patients whohad died before haemodialysis treatment could be undertaken(group I), 21 patients who had died during the first month (groupII), and 54 patients who had died after at least one month ofhaemodialysis treatment (group III). The results revealed thatthe number of patients with upper gastrointestinal tract pathologywas significantly higher in groups I and II (58% and 57% respectively)as compared to group III (31%) and controls (35%). No differencecould be demonstrated between group III and controls. The mostprevalent lesions observed were gastritis, followed by gastricand peptic ulcers. The incidence of this pathology appearedto decline as the duration of dialysis therapy increased. Mortalitycaused by upper gastrointestinal tract pathology remained highduring the first two years of treatment in group III, despitea smaller incidence of upper tract lesions. This was explainedby a relatively higher proportion of haemorrhage.     

Psychosocial adjustment and adherence to dialysis treatment regimes

Sixty children and adolescents in end-stage renal failure who were undergoing either haemodialysis or continuous ambulatory peritoneal dialysis at one of five United Kingdom dialysis centres were assessed on psychosocial adjustment and adherence to their fluid intake, diet and medication regimes. Parental adjustment was also measured and data on sociodemographic and treatment history variables collected. A structured family interview and standardised questionnaire measures of anxiety, depression and behavioural disturbance were used. Multiple measures of treatment adherence were obtained, utilising children's and parents' self-reports, weight gain between dialysis, blood pressure, serum potassium level, blood urea level, dietitians' surveys and consultants' ratings. Correlational analyses showed that low treatment adherence was associated with poor adjustment to diagnosis and dialysis by children and parents (P<0.01), self-ratings of anxiety and depression in children and parents (P<0.001), age (adolescents tended to show poorer adherence than younger children,P<0.001), duration of dialysis (P<0.05), low family socioeconomic status (P<0.05) and family structure (P<0.01). These findings demonstrate the importance of psychosocial care in the treatment of this group of children. Future research should develop and evaluate psychosocial interventions aimed at improving treatment adherence.     

BLOOD BORNE VIRUS—INNOVATIVE APPROACH TO EVALUATE,PREVENT CROSS‐TRANSMISSION IN DIALYSIS UNITS

Large public health interventions to control infectious disease outbreaks are common, but rigorous evaluation to improve the quality and effectiveness of these is rarely undertaken. This project aimed to prevent blood borne virus (BBV) cross‐transmission in dialysis units. Following an incident concerning the diagnosis of acute Hepatitis B in a haemodialysis patient, possibly from healthcare associated acquisition, a multifaceted and multidisciplinary investigation was conducted involving consumers, health professionals and administrations. The results of this investigation were then used to produce practical operational guidelines for planning and future interventions. To date, there has been no incidence reported of any cross‐transmission of BBV amongst our dialysis population. The actions implemented can be utilised by other departments in preventing other bacterial or viral outbreaks.     

Interpreting transition from adolescence to adulthood in patients on dialysis who have end-stage renal disease

Background: Patients with End-Stage Renal Disease (ESRD) undergo renal replacement therapies such as haemodialysis, and usually have to deal with a lifetime of treatment. If an individual has ESRD at a young age, eventually the individual experiences a stage of transition from adolescence to adulthood. Methods: Interpretive phenomenology was used to uncover the meaning of transition from adolescence to adulthood. Six patients on haemodialysis between the ages of 17 to 22 years agreed to participate in the study. Multiple sources of data were utilised: semi-structured interviews, video recordings, diaries and field notes. Using Ricoeur's theory of interpretation, the data were analysed. Results: Three general themes were found: Living a Shorter Life; Dependence and Independence; and Struggle of Being Normal Amidst Difference. Conclusion: Transition to Adulthood among patients with ESRD is like a pendulum continuously moving in a back and forth motion. The "World-in-Between" is a constant search of self within two ends of characteristics: of holding on and giving up; expression and non-expression of self.     

促红细胞生成素对老年血液透析患者血管活性介质的影响

目的　探讨基因重组促红细胞生成素 (r Hu EPO)对老年维持性血液透析患者血管活性介质的影响。方法　 39例基础血压正常的血透患者 ,其中 2 1例静脉 1次注射 r Hu EPO 30 0 0 U(EPO组 ) ,1 8例作为对照 (NS组 )静脉注射生理盐水。均于注射后 1、3、6、9、1 2、1 8、2 4、30、44 h放射免疫法等检测血中血管活性介质。 1 2例 EPO组患者应用 r Hu EPO60 0 0 U/ w,持续 8w后再检血中血管活性介质。结果　与 NS组相比 ,EPO组儿茶酚胺 (CA)明显升高 ;血中内皮素、肾素、醛固酮和血管紧张素 I、II两组均无明显变化。结论　 r Hu EPO可引起老年血透患者血中 CA增多。     

ULTRA VIOLET ABSORBANCE ON‐LINE MEASUREMENT UTILIZED TO MONITOR CLINICAL EVENTS DURING HAEMODIALYSIS

Background — On‐line monitoring systems of spent dialysate, used to estimate dialysis dose, have been developed with different instrumentation during the last two decades. The routine use of an on‐line monitoring system has been suggested to provide an adequate dialysis dose to the haemodialysis (HD) patient. The aim of this study was to show that monitoring the spent dialysate using UV‐absorbance might bring new information about the clearance process. Methods — 108 HD treatments distributed among 16 clinical stable patients were monitored on‐line using ultra violet (UV) absorbance. For the measurement of UV‐absorbance a spectrophotometer was connected to the fluid outlet of the dialysis machine with all spent dialysate passing through a flow cuvette. The UV‐absorbance curves were examined in combination with the recorded observations of events that occurred during the studied treatments. Results — The study demonstrates that UV‐absorbance visualizes different kinds of events such as hypotension, conductivity alarms and restricted flow in artery needle blood pump stops that often occur during dialysis treatment. Conclusion — An on‐line UV‐monitoring system with a high sampling rate makes it possible to identify variations in dialysis clearance of different origin and gives feedback after performing interventions during a dialysis session.     

肾透析患者血清中庚型肝炎病毒核酸的检测和与乙、丙型肝炎病毒同时感染分析

目的:了解肾透析患者庚型肝炎病毒(HGV)、乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)合并感染的状况。方法:应用逆转录多聚酶链反应扩增庚型肝炎病毒基因,采用蛋白酶K裂解法提取血清中HGV RNA,逆转录为cDNA后进行巢式扩增,获得238bp的特异性片段。用此方法对28例肾透析患者血清标本进行检测。结果:发现28例患者血清中有4例HGV RNA阳性。这4例患者同时合并HCV感染,其中2例为HBV、HCV、HGV合并感染。结论:肾透析患者是HGV感染的高危人群,HGV在肾透析患者中常与HCV、HBV合并感染。